Healthcare Provider Details

I. General information

NPI: 1497462592
Provider Name (Legal Business Name): PMS PRESBYTERIAN MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 INDIAN WELLS RD
ALAMOGORDO NM
88310-4609
US

IV. Provider business mailing address

2360 INDIAN WELLS RD
ALAMOGORDO NM
88310-4609
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-7404
  • Fax: 575-439-2860
Mailing address:
  • Phone: 575-437-7404
  • Fax: 575-439-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: LUIS H FUENTES
Title or Position: COMMUNITY SUPPORT WORKER - CHILDREN
Credential: CSW
Phone: 575-437-7404